Thought Records
According to Emery, the most common method by which
a client can become aware of his thinking between sessions is the use of a thought record. Your client is asked to record dysfunctional thought forms and situations
where he is anxious. Your client uses his anxiety as a cue to write out frightening
thoughts. Adam said, "Thank you" to himself after pinpointing a thought;
he then continued to ask himself what else was frightening him. The "Thank
you" reinforced himself for identifying the thoughts. Adam was then
taught to track his fears back to the original stimulus.

A thirteen-year-old client, Josh, stated he started to be anxious about the possibility of his being an alcoholic.
He said, "This just came out of the blue. I had no reason to be afraid."
After careful questioning, he discovered that his anxiety was due to seeing an
alcoholic in a television movie. His anxiety stemmed from the thought, "This
could happen to me," and the image of "ending up a drunk like my old
man." From this experience, he learned to trace his fears back to their original
stimulus or origin and then to find out how he was frightening himself.

Technique: Counting Automatic Thoughts However, as you know there are times when your client is unable to restructure
his thoughts. When he cannot slow down his mind enough to correct them or is in
a situation where he is unable to write them down, I then instruct the client
to simply count his thoughts. Counting allows your client to distance himself
from his thoughts, gives him a sense of mastery over them, and helps him to recognize
their automatic quality, rather than accepting them as an accurate reflection
of external reality. Counting automatic thoughts helps the patient to see how
his thoughts produce, maintain, and intensify his anxiety. Adam found it effective
to use an inexpensive plastic counter.

Through practice, Adam learned
to distance himself: "There's another fearful thought. I'll just count it
and let it go." I told Adam to accept the thoughts rather than fight them.
He observes his thoughts and lets them go.4 Ways to Structure Homework Assignments
Here are four ways to make
this homework assignment more structured and specific:1.Counting specific types of anxiety-producing thoughts (such as self-doubting
or catastrophic thoughts).2. Counting thoughts in the midst of
an anxiety attack, since counting may help the patient gain mastery over the situation.3. Counting during time samples (for example, between 5 p.m. and 7 p.m.).4.Counting at random timesamples of ten minutes, using a mechanical timer.

Josh, the anxious teenager, used a digital watch with a buzzer set for certain
times, which signaled him to stop what he was doing and count any threatening
thought he was having. He found that this method helped to separate him from his
thoughts. He said, "I now realize that my thoughts have a life of their own,
and I don't have to become over-concerned with them."

However, a
word of warning - make a continual assessment of the effectives to assure they
are not triggering as compulsiveness.